AAFP Statement: Budget Preserves Health System, Medicare Payment Reforms but Threatens Progress in Building Primary Care Physician Workforce

Wednesday, April 10, 2013

Statement attributable to:
Glen Stream, MD, MBI
Board Chair
American Academy of Family Physicians

“President Obama’s Fiscal Year 2014 budget sustains health system reforms that promise to improve Americans’ health, the quality of care and address the cost of health services, but it does so by risking the future health care workforce.

“The President’s budget includes several provisions that deserve support. For example, the American Academy of Family Physicians applauds efforts to reduce tobacco use among Americans. Experience has demonstrated that increased taxes on tobacco products inhibit the use of tobacco, especially among teenagers and young adults who haven’t started smoking or using other tobacco products. To that end, we welcome the proposal to raise federal taxes on tobacco.

“We also applaud President Obama’s commitment to implementing Affordable Care Act provisions that improve access to care for low-income working families, that reward quality of care through the patient-centered medical home, and that provide health security to the elderly and disabled.

“Expanding Medicaid eligibility to adults earning up to 138 percent of the federal poverty level is integral to ensuring low-income families have access to needed care. This coverage will open the door to primary medical care that can prevent illness or complications of chronic conditions, reduce avoidable emergency department or hospital use, and save money for both the health care system and the patient.

“The AAFP also is pleased the administration supports Medicare physician payment reform that will bring health care security for elderly and disabled Americans. The AAFP has called for repealing the SGR, instituting a period of stable Medicare payments, with higher payment rates for primary care, while pilot projects demonstrate the quality and cost savings in the PCMH, and a transition to payment that rewards quality of care, not quantity of services. These proposals have been made in the past and Congress has not yet passed legislation to implement them. We look forward to working with Congress to ensure that meaningful physician payment reform is achieved.

“But we’re troubled that the budget proposes across-the-board cuts to graduate medical education for teaching hospitals. Such broad and untargeted cuts would jeopardize family medicine residency programs at a time when they require critical investment to sustain the growing interest in training primary care physicians. The evidence shows that improving quality and reining in costs depend on a strong primary care foundation. We have just begun to see a turn-around in the number of students looking for family medicine residency training, but without adequate support for training these physicians, that turn-around could quickly fade.

“History has shown that academic teaching centers faced with limits on residency training funding have chosen to close primary care training residencies and add subspecialty training programs. Between 2000 and 2013, the American medical education system closed 71 family medicine programs. The trend reversed last year, when no family medicine programs closed and seven new family medicine residency programs were accredited. A blanket cut to GME could reverse that progress. If GME funding must be reduced, we call on Congress to preserve explicit support for primary care residency programs to make sure we continue to reverse the downward spiral.”

Editor's Note: To arrange an interview with Dr. Stream, contact Leslie Champlin, 800-274-2237, Ext. 5224, or lchampli@aafp.org.

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Founded in 1947, the American Academy of Family Physicians represents 136,700 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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